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Submitted: 14 Apr 2022
Accepted: 06 Jul 2022
ePublished: 02 Aug 2022
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J Nephropharmacol. 2023;12(1): e10479.
doi: 10.34172/npj.2022.10479

Scopus ID: 85146904300
  Abstract View: 9136
  PDF Download: 1531

Case Report

Acute myocarditis and acute myopathy as the first manifestations of COVID-19; a case report

Fatemeh Yaghoubi 1 ORCID logo, Farnaz Tavakoli 1* ORCID logo, Fatemeh Ghanbari 2 ORCID logo, Nasser Aghdami 3 ORCID logo, Davood Babakhani 4 ORCID logo

1 Department of Nephrology and Kidney Transplantation, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Internal Medicine Diseases, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Infectious Diseases and Tropical Medicine, Tehran University of Medical Sciences, Tehran, Iran
4 Hematology, Oncology Research Center and Stem Cell Transplantation (HORCST), Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
*Corresponding Author: Corresponding author: Farnaz Tavakoli, Email: farnaztavakkoli@gmail.com, , Email: f-tavakkoli@farabi.tums.ac.ir

Abstract

Coronavirus disease 2019 (COVID-19) mainly manifests with flu-like and respiratory symptoms such as fever, chill, myalgia, cough, dyspnea and in severe cases, it leads to acute respiratory distress syndrome and respiratory failure. However, there is evidence of extra-pulmonary involvements in patients with COVID-19. Some case reports and studies have reported severe and life-threatening complications related to COVID-19 such as cardiovascular complications (acute heart failure, myocarditis, acute coronary syndrome, thromboembolic events) and neuromuscular complications (stroke, transient ischemic attack, myositis, myopathy, Guillain-Barre syndrome). Here, we report a 51-year-old woman without a previous history of cardiovascular disease or neuromuscular disease referred to the emergency department of our hospital with new onset severe respiratory distress and progressive symmetric quadriparesis. We concluded that, the patient was infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and we therefore have encountered acute myocarditis and acute myopathy due to COVID-19 disease. In the intensive care unit (ICU), the patient was treated with oxygen therapy without mechanical ventilation, dexamethasone, intravenous human immunoglobulin (IVIG), beta interferon and remdesivir. The clinical feature, cardiac, respiratory, neuromuscular and hemodynamic parameters improved clearly five days after taking above mentioned treatments. The troponin, N-terminal pro-B type natriuretic peptide (NT-proBNP), creatine phosphokinase (CPK), returned to normal values. Following improvement of cardiac and neurologic problems, the patient was transferred from ICU to general ward and then after 10 days, she was discharged with oral anticoagulant, anti-platelet, low-dose of corticosteroids and other conservative treatments.

Implication for health policy/practice/research/medical education:

Some case reports and studies have reported severe and life-threatening complications related to coronavirus infectious disease 19 such as cardiovascular complications (acute heart failure, myocarditis, acute coronary syndrome and thromboembolic events) and neuromuscular complications [stroke, transient ischemic attack (TIA), myositis, myopathy, Guillain-Barré syndrome]. In critical cases, the immediate use of immunomodulatory drugs in addition to conservative treatments and antiviral therapy can improve the clinical outcome and prognosis of the patient.

Please cite this paper as: Yaghoubi F, Tavakoli F, Ghanbari F, Aghdami N, Babakhani D. Acute myocarditis and acute myopathy as the first manifestations of COVID-19; a case report. J Nephropharmacol. 2023;12(1):e10479. DOI: 10.34172/npj.2022.10479.

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